Multiples and PPCM

[reezlemom]

I was wondering if being pregnant with multiples is actually a risk factor or if the increased workload on the heart just makes these women more likely to present with severe enough symptoms to get a diagnosis of PPCM. I'm curious because it seems so many of us were told we had everything from asthma to bronchitis to anxiety, and I suspect more than a couple are missed the first time around until a subsequent pregnancy worsens cardiac function. To me it seems reasonable that multiples, or even a very large singleton, could increase cardiac demands to a point that PPCM symptoms would be more pronounced in these women who may have been predisposed to it anyhow and just not presented with it until a relapse in subsequent pregnancy otherwise.

[JAMESFETT]

Your thoughts on multiple gestation and risk of PPCM are probably correct. Certainly that presents the heart with additional load (stressors), making it more likely that heart failure symtoms would manifest earlier. In the largest prospective series of PPCM reported in the world in Haiti and South Africa, there is no increased incidence of twins. I think of multiple gestation pregnancy as not so much a risk factor causing the development of PPCM as a stressor that is capable of bringing out heart failure symptoms in someone who otherwise developed or is developing PPCM. However, in retrospective US series, such as reported by Elkayam, there is an increased incidence of twins. However, retrospective studies tend to overestimate things because not all cases in a given geographic area are included.

JD